Improving Cross-Cultural Communication Skills With Patients

Darcy Lewis

May 26, 2022

INDIANAPOLIS ― With a focus on helping fellow practitioners improve their patient-care skills, members of the Diversity, Equity, and Inclusion (DEI) Commission of the American Academy of Physician Associates (AAPA) presented a wide-ranging session on cross-cultural communication at the group's 2022 annual meeting.

Robert Lee Wooten

Commission chair Robert Lee Wooten, PA-C, noted that cross-cultural communication is a process of creating and sharing meaning among people who have different cultural backgrounds. "It can be accomplished in a variety of ways, including spoken, written, or signed words," he said. "But accents, tone, body language, idioms, and many elements all play a role. And it does not just mean people from a country other than yours; think of the differences between people from the Deep South and California."

As practitioners, improving cross-cultural communication skills helps ensure that medical messages are understood as intended, said commission member Jonathan P. Clemens, PA-C, ThM. Other positive effects of honing these skills include the following:

  • Feeling at home with a group other than your own

  • Greater understanding of others' perspectives

  • Increased respect for others' lived experiences

Clemens suggested starting with the idea that others aren't wrong or inferior just because they're different. "That means starting every interaction with the thought that I can do better and I can learn," he said.

Clemens noted several factors that affect cross-cultural communication and that can affect the quality of care that patients receive:

  • Social organization: Multiple family members may attend a patient's appointment and expect to be included in all discussions and decision-making, Clemens said.

  • Conception of authority: Depending on their background, asking some patients their treatment preferences can be confusing, because they may expect authority figures to tell them what to do, Clemens said.

  • Nonverbal communication: In some cultures, direct eye contact is considered rude. Also, some persons may nod or smile as a matter of courtesy, not because they understand medical instructions or plan to comply with them, Clemens said.

Communication Strategies

AAPA's DEI Commission has identified strategies to assist practitioners who want to improve their cross-cultural communication skills:

  • Distinguish perspectives.

  • Build awareness.

  • Recognize complexity.

  • Avoid stereotyping.

  • Respect differences.

  • Listen actively.

  • Be honest.

  • Be flexible.

  • Ask questions.

  • Think twice before making the same mistake again.

Deanna Bridge Najera

As for that last point, commission member Deanna Bridge Najera, PA-C, MPAS, noted that making the occasional cross-cultural gaffe is inevitable. "We all make mistakes. It's what you do next that matters," she said. "Do you say: 'I'm sorry; that came out totally wrong'? Think about changing your language and cultural skill set so that you can have better interactions and grow from the experience."

Avoid Harmful Stereotypes

Bridge Najera noted that stereotyping patients can feel like a way to make a busy day more manageable but urged against taking this shortcut.

"When you have yet another patient with low-back pain in clinic and you're running behind, it can be easy to see drug-seeking behavior," Bridge Najera said. "Instead, really listen to your patient instead of just planning your next question, and focus on ruling out an abdominal aortic aneurysm, discitis, or a epidural abscess."

Dr Robert Smith

Above all, be empathetic, said commission member Robert Smith, PA-C, DHSc. "I view every day as an opportunity to learn not to judge someone else," he said.

Names Matter

The question of how to address patients came up several times during the session. The consensus among presenters was that using the patient's preferred and/or correct name is especially important for healthcare providers to show cultural humility. That might mean taking time to practice saying the name correctly, Smith said.

Clemens noted that his surname was frequently misspelled during his childhood. "That's why I value having names that are very bland when other cultures don't," he said. "I had to unlearn my values to respect people and treat them with dignity, even if their name is unique among 8 billion people."

Wooten noted that a particular peeve of his is when healthcare providers default to addressing patients older than them by their first name. "In Black culture, calling elders by their first name without permission is considered extremely disrespectful," he said. He recounted a patient interaction in which an older Black woman declined to continue to be treated by a young nurse who addressed her by her first name.

"If she had asked me first, I probably would have told her to use my first name, but she took that choice away from me," the patient said. To Wooten, that was a good example of a provider not being culturally sensitive and not wanting to learn, at least on that day.

When an audience member asked the presenters how she, a White woman, could convince her patients of color that she would not repeat any poor or inappropriate treatment they had received in the past, Wooten thanked her for being willing to display vulnerability by asking that question.

"The fact is that people of color have long been mistreated by the medical system, so there is a lot of reason for mistrust," he said. "You're not going to change the past or fix generational problems, but you can help that patient today. Give your best every day. That's all you can do."

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